Outcome of very low birth weight infants exposed to antenatal indomethacin for tocolysis

被引：16

作者：

Doyle N.M. ^{[1
,5
]}

Gardner M.O. ^{[2
]}

Wells L. ^{[3
]}

Qualls C. ^{[4
]}

Papile L.-A. ^{[3
]}

机构：

[1] Department of Obstetrics, Division of Maternal Fetal Medicine, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX

[2] Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX

[3] Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM

[4] General Clinical Research Center, University of New Mexico School of Medicine, Albuquerque, NM

[5] Houston, TX 77030

来源：

Journal of Perinatology | 2005年 / 25卷 / 5期

关键词：

D O I：

10.1038/sj.jp.7211256

中图分类号：

学科分类号：

摘要：

Objective: Beginning in October 1995, and for several years thereafter, our institution used indomethacin as a first-line tocolytic drug. Our purpose is to compare the outcomes of very low birth weight infants who were exposed to antenatal indomethacin with those who were not exposed to this therapy. Study design: We used our center's component of the NICHD Neonatal Research Network's Generic Data Base which recorded the outcomes of all live born infants weighing less than 1500 g over a 5-year period. We abstracted data concerning neonatal morbidity (death, Grades III to IV intraventricular hemorrhage (IVH), necrotizing enterocolitis and patent ductus arteriosus), as well as other factors including gestational age, birth weight, antenatal corticosteroid treatment and maternal hypertension or pre-eclampsia. Univariate analysis was performed using Fisher's exact test. Multivariate analysis using logistic regression was performed to control for confounding factors. Results: A total of 85 infants who were exposed to antenatal indomethacin were compared to 464 infants who were not exposed to the drug. In the univariate analysis, antenatal indomethacin exposure was not associated with a significant increase in the incidence of necrotizing enterocolitis or patent ductus arteriosus. The incidence of Grades III to IV IVH was 17.9% in those infants exposed to antenatal indomethacin compared to 7.1% in the nonexposed infants (p = 0.008). The incidence of neonatal death in the exposed infants was 27.7 versus 16.4 in the nonexposed infants (p = 0.02). After controlling for antenatal corticosteroids, maternal pre-eclampsia, gestational age and birth weight, antenatal indomethacin was significantly associated with an increased incidence of IVH, but not neonatal death. Conclusion: Antenatal indomethacin was associated with significantly higher rates of IVH. Additional studies assessing the potential risk of indomethacin tocolysis are needed before it is used as a first-line tocolytic therapy. © 2005 Nature Publishing Group All rights reserved.

引用

页码：336 / 340

页数：4

共 25 条

[11]

Niebyl J.R., Blake D.A., White R.D., Et al., The inhibition of preterm labor with indomethacin, Am. J. Obstet. Gynecol., 136, pp. 1014-1019, (1980)

[12]

Morales W.J., Madhav H., Efficacy and safety of indomethacin compared with magnesium sulfate in the management of preterm labor: A randomized study, Am. J. Obstet. Gynecol., 169, pp. 97-102, (1993)

[13]

Kurki T., Eronen M., Lumme R., Ylikorkata O., A randomized double-dummy comparison between indomethacin and nylidrin in threatened preterm labor, Obstet. Gynecol., 78, pp. 1093-1097, (1991)

[14]

Katz Z., Lancet M., Mogliner B.M., Feigl A., Ben H.H., Treatment of premature labor contractions with combined Ritodrine and indomethacin, Int. J. Gynaecol. Obstet., 21, pp. 337-342, (1983)

[15]

Higby K., Xenakis E., Pauerstein C., Do tocolytic agents stop preterm labor? A critical and comprehensive review of efficacy and safety, Am. J. Obstet. Gynecol., 168, pp. 1247-1259, (1993)

[16]

Merrill J.D., Clyman R.I., Norton M.E., Indomethacin as a tocolytic agent: The controversy continues, J. Pediatrics, 124, pp. 734-735, (1994)

[17]

Norton M.E., Merrill J., Cooper B.A., Kuller J.A., Clyman R.I., Neonatal complications after the administration of indomethacin for preterm labor, N. Engl. J. Med., 329, pp. 1602-1607, (1993)

[18]

Major C.A., Lewis D.F., Harding J.A., Porto M.A., Garite T.J., Tocolysis with indomethacin increases the incidence of necrotizing enterocolitis in the low birth weight neonate, Am. J. Obstet. Gynecol., 170, pp. 102-106, (1994)

[19]

Gardner M.O., Owen J., Skelly S., Hauth J.C., Preterm delivery after indomethacin: A risk factor for neonatal complications, J. Reprod. Med., 41, pp. 903-906, (1996)

[20]

Fanaroff A.A., Wright L.L., Stevenson D.K., Et al., Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992, Am. J. Obstet. Gynecol., 173, pp. 1423-1431, (1995)

← 1 2 3 →